Incidence of Adverse Cardiac Events After Liver Transplantation in Patients With Different Hemodynamic Classifications of Pulmonary Hypertension.

Abstract

Introduction: Pulmonary hypertension (PH) in liver transplantation candidates is associated with elevated morbidity and mortality. Few studies have investigated whether different categories of PH based off hemodynamic characteristics portend worse outcomes. Furthermore, there have been newly defined parameters for PH classifications. Therefore, we aimed to compare postoperative outcomes after liver transplantation in patients within different newly established hemodynamic categories of PH.

Methods: This was a 20-year single-center retrospective observational study of adult patients undergoing liver transplantation. Patients with a diagnosis of PH and confirmatory right heart catheterization (RHC) were included in the study. Based off pulmonary artery wedge pressure (PAWP) and Wood units (WU), patients were categorized into four groups: precapillary (PrePH), isolated postcapillary (IpcPH), combined postcapillary (CpcPH), unclassified (UncPH). Our primary outcome was a composite of adverse cardiac events within 30 days postoperatively. Secondary outcomes included prolonged ventilation, acute kidney injury, and mortality at 30 days, 6 months, and 1 year.

Results: Of the 2409 patients who underwent liver transplantation in the study period, 80 patients met criteria for inclusion. The incidences of ACEs were 0% in PrePH, 31.4% in IpcPH, 25.0% in CpcPH, and 10.3% in UncPH (p = 0.04). Patients with postoperative ACEs had elevated PAWP (18.1 vs. 14.0 mmHg, p = 0.01) and lower pulmonary vascular resistance (0.79 vs 1.3 WU, p = 0.01). There were no differences observed in secondary outcomes.

Conclusion: In this single-center study, we observed that patients with isolated precapillary PH did not have adverse cardiac events. Instead, patients with elevated PAWP, indicating postcapillary PH, were more likely associated with adverse cardiac events. This observation is seen despite milder pulmonary disease, as intended by newly established definitions for PH. Further investigation is warranted, as there may be prognostic implications that can drive future guidelines for liver transplantation in patients with PH.